# Sclerotherapy (DD-597)

> Sclerotherapy treats unwanted veins by injecting a solution (a sclerosant) that damages the vein's inner lining, the endothelium. The vein then becomes inflamed, scars and closes, and over weeks to months the body clears it and it fades. It's used for spider veins (telangiectasias), small reticular veins and some varicose veins. For larger varicose veins, the sclerosant is often whipped into a foam and injected under ultrasound guidance, a technique NICE has assessed in its guidance. The sclerosants in widest use are detergents such as polidocanol and sodium tetradecyl sulfate, which break down the cell membranes of the lining. Hypertonic saline, a concentrated salt solution, works by drawing water out of the cells. It's one option, but not the usual one, and ordinary saline wouldn't close a vein. Several sessions may be needed. Clinical sources list common effects such as pain at the injection site, bruising, temporary lumps, brown staining of the skin and new tiny red veins ('matting'). They list rare complications including skin ulcers, allergic reactions, and clots in deeper veins. This case is general information, not medical advice. The footage shows a needle injecting into small purple veins on a leg.

- Department: Science (also People)
- First published: 2025-06-16
- Last updated: 2025-06-16
- Permalink: https://detailenjoyer.com/case/sclerotherapy/
- Author: Marcus Easterling (DetailEnjoyer), The Detail Department

## Quick facts

- **DD-597-F01**: Sclerotherapy closes veins by damaging their lining. _(Write-up · Exhibit A (Damage on purpose))_
- **DD-597-F02**: Polidocanol is a detergent-type sclerosant. _(Write-up · Exhibit A (Damage on purpose))_

## Write-up

Closing veins from the inside. Sclerotherapy injects a solution that seals small veins shut.

1. **Damage on purpose**: A sclerosant injures the vein's inner lining, so the vein scars, closes and fades.
2. **Detergents lead**: Polidocanol and sodium tetradecyl sulfate are detergents that break down the lining's cells.
3. **Salt is the alternative**: Hypertonic saline works by drawing water out of the lining's cells.
4. **Foam for bigger veins**: For larger varicose veins, sclerosant foam is injected under ultrasound guidance.
5. **Known side effects**: Clinical sources list bruising, staining and new tiny veins, and rarely ulcers or clots.

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## Reel vs. record

- **Note**: 'Typically a saline solution': the most widely used sclerosants are detergents such as polidocanol and sodium tetradecyl sulfate. When salt is used, it's concentrated (hypertonic) saline, not ordinary saline.
- **Note**: 'Varicose and spider veins': the classic needle injections suit spider and small reticular veins. Larger varicose veins are often treated with foam sclerosant guided by ultrasound, or with other procedures.
- **Note**: 'Gradually reabsorbed': clinical sources say treated veins fade over weeks to months, and several sessions may be needed.
- **Missing**: clinical sources list side effects such as bruising, brown staining of the skin and new tiny red veins, and rare complications including skin ulcers and clots.
- **Note**: 'Irritates the vein's inner lining': correct in principle. Detergents break down the lining's cell membranes, while hypertonic saline draws water out of the cells. Either way, the vein scars and closes.

## Video: Sclerotherapy: Closing Veins From the Inside

- Duration: 20.7 s · Published: 2025-06-16
- File: https://detailenjoyer.com/assets/videos/DK-LPTCSLj9.mp4

### Transcript

DID YOU KNOW? Vascular sclerotherapy is a medical procedure used to treat varicose and spider veins. A sclerosing agent, typically a saline solution or chemical like polidocanol, is injected directly into the affected vein. This irritates the vein's inner lining, causing endothelial damage and inflammation. The vein collapses, forms scar tissue, and is gradually reabsorbed by the body. NOW YOU KNOW!

## Questions & answers

**Q: What does a sclerosant damage?**  
A: The endothelium. _(Source: Write-up · Exhibit A (Damage on purpose) · StatPearls (NCBI Bookshelf): Sclerotherapy; DermNet: Sclerotherapy)_

**Q: What kind of agent is polidocanol?**  
A: It breaks down the lining's cell membranes. _(Source: Write-up · Exhibit B (Detergents lead) · StatPearls (NCBI Bookshelf): Sclerotherapy; Sclerotherapy for lower limb telangiectasias, Cochrane review (PMC))_

**Q: How does hypertonic saline work?**  
A: Osmotic injury. _(Source: Write-up · Exhibit C (Salt is the alternative) · StatPearls (NCBI Bookshelf): Sclerotherapy; Sclerotherapy for lower limb telangiectasias, Cochrane review (PMC))_

**Q: How are larger varicose veins often treated with sclerotherapy?**  
A: As assessed in NICE guidance. _(Source: Write-up · Exhibit D (Foam for bigger veins) · NICE HTG301: Ultrasound-guided foam sclerotherapy for varicose veins, the procedure)_

**Q: Which side effect do clinical sources list?**  
A: Along with bruising and new tiny veins. _(Source: Write-up · Exhibit E (Known side effects) · DermNet: Sclerotherapy; Cleveland Clinic: Sclerotherapy)_

## Sources

- [StatPearls (NCBI Bookshelf): Sclerotherapy](https://www.ncbi.nlm.nih.gov/books/NBK599526/)
- [Sclerotherapy for lower limb telangiectasias, Cochrane review (PMC)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7389636/)
- [DermNet: Sclerotherapy](https://dermnetnz.org/topics/sclerotherapy)
- [NICE HTG301: Ultrasound-guided foam sclerotherapy for varicose veins, the procedure](https://www.nice.org.uk/guidance/htg301/chapter/2-The-procedure)
- [Cleveland Clinic: Sclerotherapy](https://my.clevelandclinic.org/health/treatments/6763-sclerotherapy)

## Cite this case file

Easterling, Marcus. "Sclerotherapy." The Detail Department (DetailEnjoyer), case file DD-597, last updated Jun 16, 2025. https://detailenjoyer.com/case/sclerotherapy/